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Anatomy > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Calcaneus: Description

A

The calcaneus is the largest of the tarsal bones and is colloquially refered to as the heel bone.
Function: Inversion and eversion, transfer of force between the leg and the heel pad.
Location: below the talus

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2
Q

Calcaneus: Gross Anatomy

A
  • Irregular box shaped bone

Features:

  • Calcaneal tuberosity (heel) – posterior projection with:
    • Lateral process
    • Medial process
    • Posteriorly – superior, middle (attachment for the Achilles) and inferior facet
  • Sustentaculum tali – antero-medial process inferior to which is a groove from the flexor halluces longus
  • Dorsal surface – location of the anterior, middle and posterior talocalcaneal facets, the tarsal sinus runs between the middle and posterior facets.
  • Anterior process - anterior projection the anterior surface of which has the facet for the cuboid
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3
Q

Calcaneus: Articulation

A
  • Talus via the anterior, middle and posterior articular facets
  • Cuboid via the facet for the cuboid on the anterior surface
  • Shares a joint space with the talonavicular joint forming the talocalcaneonavicular joint
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4
Q

Calcaneus: Relations

A
  • Superior: talocalcaneal joint, talus, sinus tarsi
  • Inferior: fad pad, long and short plantar ligaments
  • Anterior: calcaneocuboidal joint, cuboid bone
  • Posterior: Achilles tendon
  • Medial: Tendon of flexor hallucis longus, deltoid ligament of the ankle, tibial nerve, posterior tibial artery
  • Lateral: Tendons of peroneus longus and brevis
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5
Q

Calcaneus: Neurovasculature

A
  • Medial and lateral calcaneal arteries from the posterior tibial and fibular arteries
  • Artery of the tarsal sinus

Innervation:

  • Tibial, sural and deep fibular nerves
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6
Q

Calcaneus: Variants

A
  • Talocalcaneal coalition
  • Calcaneonavicular coalition
  • Os calcaneus secundaris
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7
Q

Femur: Description

A

Long bone of the thigh
Function: transfer force between the hip and leg

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8
Q

Femur: Gross Anatomy

A

Proximal portion:

  • Head globular hemisphere covered in synovial cartilage except for the central fovea (attachment of ligamentum terres)
  • Neck thinner process through which a large majority of the blood supply to the head flows
  • Greater trochanter – large irregular lateral attachment site
  • Lesser trochanter – conical posteromedial attachment site
  • Intertrocanteric line anteriorly
  • Intertrocanteric crest posteriorly

Shaft:

  • Long
  • Linea aspera – posterior ridge that serves as the attachment for multiple muscle and the intermuscular septa, 3 ridges superiorly becomes two ridges inferiorly that diverge to for the triangular popliteal surface

Distal:

  • Flared head with two rounded synovial line condyles
  • Synovial surface anteriorly for articulation with the patella
  • Bilateral epicondyles superior to each condyle
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9
Q

Femur: Joints

A

Femoroacetabular – femoral head with the acetabulum, synovial ball and socket with fibrous capsule
Patellofemoral – between the patella groove and the articular surface of the patella
Tibiofemoral – between the medial and lateral condyles and the medial and lateral tibial plateau

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10
Q

Femur: Neurovasculature

A

Arterial:

  • Artery of ligamentum terres
  • Anterior and posterior humeral circumflex
  • Perforating braches from profunda femoris
  • Popliteal and genicular arteries distally

Venous:

  • Anterior and posterior femoral circumflex veins to the greater saphenous veins
  • Popliteal and deep femoral veins to the common iliac veins

Innervation:

  • Femoral and tibial nerves
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11
Q

Femur: Variants

A
  • Coxa valgus/varus
  • Hip dysplasia
  • Os acetabula
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12
Q

Patella: Description

A

The patella is the largest sesamoid bone in the human body. It lies within the quadriceps tendon / patellar ligament and forms part of the knee joint.

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13
Q

Patella: Articulation

A

Articular surface is covered in hyaline cartilage. It articulates with the trochlear groove of the femur (anterior distal surface between the medial and lateral condyles).

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14
Q

Patella: Gross Anatomy

A
  • The patella is triangular in shape with a superior base and inferior apex.
  • The posterior surface is smooth, composed of articular cartilage, and is divided into medial and lateral facets, which are sub divided into superior, middle and inferior portions.
  • The lateral facet is the largest (this counters the tendency for the quadriceps to pull the patella laterally).
  • The anterior surface is rough, for attachment of tendons and ligaments.
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15
Q

Patella: Attachments

A

Ligaments:

  • Patellar ligament – from the apex of the patella to the tibial tuberosity
  • Medial and lateral patellar retinaculum
  • Medial and lateral patellofemoral ligament (MPFL and LPFL).

Muscles:

  • Quadriceps tendon superiorly (really the same thing as the patellar ligament).
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16
Q

Patella: Relations

A
  • superior: common tendon of quadratus femoris, suprapatellar bursa
  • inferior: patellar tendon, infrapatellar bursa, infrapatellar fat pad
  • lateral: lateral patellar retinaculum
  • medial: medial patellar retinaculum
  • posterior: knee joint, femur
  • anterior: prepatellar bursa
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17
Q

Patella: Neurovsculature

A

Blood supply:

  • Anastomotic rings formed from the branches of the superior and inferior geniculate arteries

Innervation:

  • branches of nerves to vastus medialis and vastus lateralis
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18
Q

Patella: Variants

A
  • bipartite patella
  • multipartite patella
  • absent patella
  • variation in shape (see: Wiberg classification)
  • dorsal defect of the patella (may occasionally be symptomatic)
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19
Q

Knee Joint: Description

A

The knee joint is a modified hinge joint between the thigh and the leg
Movements: Flexion and extension

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20
Q

Knee Joint: Gross Anatomy

A

Type: Synovial joint with a capsule (largest synovial joint in the body)
Articulations:

  • Femoral condyles with tibial plateaus
  • Patella with the patella groove of the femur
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21
Q

Knee Joint: Ligaments

A
  • Medial collateral ligament
  • Lateral collateral ligament
  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Meniscofemoral ligaments
  • Anterolateral and posterolateral ligaments
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22
Q

Knee Joint: Menisci

A
  • Medial – larger, c-shaped, attached to the MCL laterally
  • Lateral – smaller, almost a complete circle
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23
Q

Knee Joint: Bursa

A
  • Pre-patella bursa
  • Supra-patella bursa
  • Deep and superficial Infrapatella bursa
  • Semimembranous bursa
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24
Q

Knee Joint: Fat pads

A
  • Hoffa’s deep to the patella tendon
  • Suprapatella fat pad
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25
Q

Knee Joint: Neurovasculature

A

Arterial supply:

  • Superior and inferior, medial and lateral, Genicular branches of the popliteal artery
  • Descending genicular from the femoral
  • Descending branch of the lateral circumflex
  • Circumflex fibular

Venous: into the popliteal and femoral veins

Innervation: Femoral and genicular branches from the tibial and fibular nerves

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26
Q

Knee Joint: Variants

A
  • Patella – dorsal patella defect, bipartite, absent
  • Baker’s cyst
  • Discoid meniscus
  • Flabella
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27
Q

Hamstrings: Description

A

The hamstrings are the muscles of the posterior compartment of the thigh and include the:

  • lateral: biceps femoris
  • medial: semimembranosus and semitendinosus

Function: flex knee and extend hip

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28
Q

Hamstrings: Gross anatomy

A

Apart from the short head of biceps femoris, the muscles share two common features:

  • span both the hip and knee joints
  • originate from the ischial tuberosity

The short head of the biceps femoris originates from the linear aspera

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29
Q

Hamstrings: Biceps femoris

A

2 heads (long and short)
Origin is the Ischial tuberosity (long) and linea aspera (short)
Insertion is the fibular head
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

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30
Q

Hamstrings: Semitendinosus

A

Origin Ischial Tubersotirty
Accompanies semimembranoiss however forms tendon 2/3 down thigh
Inserts on the medial superior tibial condyle, pes anserisus posterior to the gracillis
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

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31
Q

Hamstrings: Semimembranosus

A

Origin Ischial tuberositiy
Inserts on the medial tibial condyle and posterior joint capsule
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

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32
Q

Hamstrings: Pes Anserius

A
  • Sartorius
  • Gracilis
  • Semitendinoisis
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33
Q

Gastrocnemius: Attachments

A
  • origin: above the lateral and medial femoral condyle
  • insertion: calcaneal (Achilles) tendon into mid-posterior calcaneus
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34
Q

Gastrocnemius: Neurovasculature

A
  • arterial supply: sural arteries
  • innervation: tibial nerve (sciatic nerve nerve roots S1 and S2)
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35
Q

Gastrocnemius: Description

A

antagonist: tibialis anterior
action: plantar flexes foot and flexes knee

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36
Q

Gastrocnemius: Relations

A
  • superficial to soleus
  • forms the inferior borders of the popliteal fossa
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37
Q

Gastrocnemius: Variants

A

Fabella

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38
Q

Soleus: Attachments

A
  • origin: fibula and medial border of the tibia (soleal line) via the inverted tendinous arch
  • insertion: tendo calcaneus (Achilles tendon) into mid-posterior calcaneus
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39
Q

Soleus: Neurovasculature

A
  • arterial supply: sural arteries
  • innervation: tibial nerve (sciatic nerve roots L5 to S2)
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40
Q

Soleus: Relations

A

deep to the gastrocnemius

the popliteal artery and tibial nerve exit the popliteal fossa by passing under the tendinous arch

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41
Q

Soleus: Variants

A
  • Accessory soleus Muscle
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42
Q

Arterial Supply of the foot: Description

A

Arterial supply of the foot is the vascular system that supplies oxygenated blood to the foot

Gross anatomy:
The arterial supply of the foot can be divided into plantar and dorsal components:

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43
Q

Medial Plantar artery

A

Origin: posterior tibial branch
Supplies: the medial side of the foot and the first toe
Termination: the 1 st medial plantar digital artery

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44
Q

Lateral Plantar artery

A

Origin: Posterior tibial artery
Course: Cross the foot toward the base of the 5 th metatarsal
Supplies: lateral intrinsic muscle of the foot
Termination: As the Plantar arch

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45
Q

Plantar arch

A

Connects the dorsalis pedis with the lateral plantar artery
Lies deep to the plantar aponeurosis
Branches: Plantar metatarsal arteries
Termination: connects with dorsalis pedis in the first metatarsal interspace

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46
Q

Dorsal Arterial Supply of the foot

A

Dorsalis pedis
Origin: Continuation of the anterior tibial artery
Course: Runs lateral to the extensor halluces longus tendon
Termination: continues as the first metatarsal artery
Branches:

  • First dorsal metatarsal artery
  • Medial tarsal arteries
  • Lateral tarsal arteries
  • Arcuate artery
  • Dorsal metatarsal arteries
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47
Q

Popliteal Artery: Description

A

Large artery of the popliteal fossa
Supplies: Primary supply for the leg below the knee

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48
Q

Popliteal Artery: Gross Anatomy

A

Origin: A continuation of the superficial femoral artery as it passes out of the adductor hiatus
Course:

  • Through the popliteal fossa where it is the deepest structure
  • Through the fibrous arch of soleus

Termination:
Bifurcation into the anterior tibial and the tibioperoneal trunk

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49
Q

Popliteal Artery: Branches

A

Medial and lateral, superior and inferior genicular arteries
Middle genicular artery

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50
Q

Popliteal Artery: Relation

A

Popliteal artery is the most deep structure in the popliteal fossa
Deep to the popliteal vein

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51
Q

Popliteal Artery: Variation

A
  • Trifurcation
  • Peroneal from the anterior tibial
  • High origin of the anterior tibial
  • High origin of the posterior tibial
  • Very long tibioperoneal trunk
  • Hypoplastic infrapopliteal vessels
  • Popliteal artery entrapment
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52
Q

Great Saphenous Vein: Description

A

The long and short saphenous veins are superficial veins of the lower limb
Function: return oxygenated blood from the lower limb to the iliac veins
Gross anatomy:
Both have valves

Origin: continuation of the medial marginal vein of the foot

Termination: Pierces the deep facia of the femoral triangle draining into the saphenofemoral junction. 99% have a valve within 2mm of the SFJ

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53
Q

Great Saphenous Vein: Course

A

It passes anterior to the medial malleolus, ascending in the saphenous space between the saphenous fascia superficially and the deep fascia, it is closely related to the saphenous nerve(s) below the knee.

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54
Q

Great Saphenous Vein: Tributaries

A
  • Small saphenous vein
  • Unnamed superficial veins of the leg
  • Medial marginal vein of the foot
  • Superficial epigastric
  • Superficial circumflex iliac
  • Superficial external iliac
  • Superficial external pudendal
  • Multiple deep perforators to the deep system
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55
Q

Lesser Saphenous Vein: Description

A

Origin: Confluence of the lateral aspect of the venous network of the dorsum of the foot

Termination: Pierces the deep fascia of the popliteal fossa to drain into the popliteal vein

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56
Q

Lesser Saphenous Vein: Course

A

Posterior to the lateral malleolus, ascending in the subcutaneous tissues of the lateral leg

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57
Q

Lesser Saphenous Vein: Tributaries

A
  • Multiple unnamed superficial branches
  • Great saphenous vein
  • Multiple perforators to the deep venous system
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58
Q

Lesser Saphenous Vein: Relations

A

Course closely associated with the sural nerve

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59
Q

Lesser Saphenous Vein: Variants

A
  • Vein of Giacomini
  • Duplication
  • Absence
  • Fenestration
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60
Q

Talus: Description

A

The talus is a tarsal bone in the hindfoot that articulates with the tibia, fibula, calcaneus, and navicular bones. It has no muscular attachments and around 60% of its surface is covered by articular cartilage.

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61
Q

Talus: Gross anatomy

A

Body:

  • The talar body has a curved smooth talar dome, which is covered with cartilage.
  • Other parts of the talar body include the central portion, the posterior process and the lateral process.

Head:

  • The talar head is the part that articulates with the navicular bone.

Neck:

  • The talar head and body are connected by the talar neck, which is inclined downwards distally and medially.
  • The medial surface of the talar neck has a sulcus, the sulcus tali, that forms the tarsal sinus with calcaneual sulcus of the calcaneum
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62
Q

Talus: Articulation

A
  • Talar body: tibia, fibula and calcaneus
  • Talar head: navicular bone
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63
Q

Talar ligaments

A

Lateral:

  • Anterior talofibular ligament
  • Posterior talofibular ligament
  • Talocalcaneal ligaments

Deep:

Tarsal sinus ligaments:

  • cervical ligament
  • talocalcaneal interosseous ligament

Medial:

Deltoid ligament:

  • anterior tibiotalar ligament
  • posterior superficial tibiotalar ligament
  • posterior deep tibiotalar ligament
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64
Q

Talus: Neurovasculature

A

Anterior and posterior tibial arteries

Peroneal artery

The vascular supply to the talus is considered tenuous due to the lack of muscular attachment to the bone

Innervation: deep peroneal nerve, tibial nerve, saphenous nerve, sural nerves

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65
Q

Talus: Variant anatomy

A
  • talocalcaneal coalition
  • the posterior process of the talus may not be fused to the central portion of the body, resulting in an os trigonum
  • congenital vertical talus
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66
Q

Tibia: Description

A

The tibia is the largest bone of the leg and contributes to the knee and ankle joints. It is medial to and much stronger than the fibula, exceeded in length only by the femur.

Osteology

The tibia has a prismoid shaft, expanded ends, proximal larger condylar shelf articulating at the knee, and distal smaller end with a strong medial malleolus forming the ankle.

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67
Q

Tibia: Gross anatomy

A

Proximal tibia

  • The tibia has a broad weight-bearing surface consisting of the medial and lateral condyles.
  • The intercondylar area separates the medial and lateral plateau and is divided into the anterior and posterior areas.
  • The tibial tuberosity is an anterior bony projection that receives the patellar tendon attachment and is separated from the skin by the subcutaneous infrapatellar bursa.
  • Gerdy’s tubercle is located at the anterolateral aspect of the proximal tibia, where the iliotibial band (ITB) attaches.

Shaft

  • The diaphysis of the tibia is triangular in cross section and has medial, lateral and posterior surfaces

Distal tibia

  • The slightly expanded end of the tibia is rotated laterally (tibial torsion) and has five surfaces, namely, anterior, posterior, medial, lateral and distal. The lateral surface exhibits a triangular notch which attaches to the fibula.
68
Q

TIbia: Articulations

A

The medial and lateral condyles articulate with corresponding femoral condyles at the knee. The lateral condyle of the proximal tibia has a circular facet articulating with the fibula at the proximal tibiofibular joint.

The distal articular surface of tibia is concave sagittal and slightly convex transversely. The concave surface (also called the sellar surface) fits over the dome of talus at the talocrural joint (a.k.a. tibiotalar joint)

69
Q

Tibia: Musculotendinous attachments

A
  • tensor fascia latae muscle at Gerdy’s tubercle via the iliotibial band
  • quadriceps femoris at the tibial tuberosity
  • sartorius, gracilis, semitendinosus form a wide insertional slip called the pes anserinus with an underlying pes anserine bursa
  • horizontal head of semimembranosus inserts at medial condyle
  • popliteus at posterior tibia above the soleal line.
70
Q

Tibia: Muscular origins

A
  • tibialis anterior muscle at the lateral tibia
  • extensor digitorum longus along the lateral tibial shaft
  • soleus muscle from the soleal line on the posterior tibia
  • flexor digitorum longus muscle on the posterior tibia distal to soleal line.
71
Q

Tibial Ligaments

A
  • Medial and lateral collateral ligaments of the knee
  • Anterior and posterior tibiotalar
  • Tibiocalcaneal
72
Q

Tibia: Neurovasculature

A

Blood supply:

  • Geniculars
  • Anterior and posterior tibial

Nerve supply

Proximally innervated by branches supplying the knee joint, distally by those supplying the ankle. The periosteum of the diaphysis receives nerve twigs from the overlying muscles attaching to the tibia.

73
Q

Tibia Variant anatomy

A

Ball and socket ankle joint

74
Q

Fibula: Description

A

The fibula is the smaller of the two bones of the leg. It is not directly involved in the transmission of weight but is important for ankle stability and acts as a source for numerous muscle attachments.

Osteology

Consists of a head, neck, shaft and distal malleolus.

75
Q

Fibula: Gross anatomy

A

Head

  • The proximal head is irregular with a small superiorly pointed tubercle called the styloid process.
  • The proximomedial head articulates with the tibia to form the superior tibiofibular joint via a rounded facet.
  • The neck is just inferior to the head.

Shaft

Triangular in shape

Lateral malleolus

The lateral malleolus forms the lateral part of the mortise and extends more distally and posteriorly than the medial malleolus.

76
Q

Fibula: Articulations

A

The fibula contributes to the ankle joint but is not involved in the knee joint directly:

  • Proximal: superior tibiofibular joint
  • Distal: talocrural joint, inferior tibiofibular joint (tibiofibular syndesmosis joint)
77
Q

Fibular attachments

A

Musculotendinous

Proximal/head

  • biceps femoris
  • extensor digitorum longus
  • soleus

Medial surface

  • extensor digitorum longus
  • peroneus tertius
  • extensor hallucis longus

Lateral surface

  • peroneus longus
  • peroneus brevis

Posterior surface

  • tibialis posterior
  • soleus
  • flexor hallucis longus
78
Q

Fibula: Ligaments

A
  • Anterior and posterior proximal tibiofibular ligaments
  • Fibular collateral ligament of the knee joint
  • Interosseous membrane
  • Anterior inferior and posterior inferior tibiofibular ligaments
  • superior extensor retinaculum and superior peroneal retinaculum of the ankle
79
Q

Fibula: Relations

A

The lateral part of the fibular neck accommodates the common fibular nerve. The peroneus longus and brevis tendons pass behind the lateral malleolus with the peroneus tertius passing in front.

In relation to the fascial compartments of the leg:

  • the anterior compartment sits anterior to the fibula
  • the lateral compartment sits lateral to the fibula
  • the deep posterior compartment sits medial to the fibula
  • the superficial posterior compartment sits posterior to the fibula

At the lateral malleolus, the peroneus brevis tendon passes behind the malleolus closest to the bone, anterior to the peroneus longus tendon (memory aid: brevis closest to bone).

80
Q

Fibula: Neurovasculature

A

Arterial:

Perforators of Fibular artery branch of the tibioperoneal trunk

Venous:

Fibular vein draining into the TP trunk / popliteal veins

Innervation:

Common fibular nerve

81
Q

Fibula: Variant anatomy

A

Fibular hemimelia

Os sub fibulare

Ball and socket talocrural joint

82
Q

Hip Joint: Description

A

Deep synovial ball and socket joint between the femoral head and the acetabulum (roman vinegar cup!).

Movements:

Flexion, extension, abduction, adduction, internal and external rotation

83
Q

Hip Joint: Gross anatomy

A
  • Acetabulum formed by the fusion of the ishium, ilium and pubis, cup like, deepened by the fibrocartilage labrum.
  • The labrum encircles the acetabulum and is completed inferiorly by the transverse acetabular ligament.
  • Femoral head, globular lined with synovial cartilage except for central fovea.
  • Capsule from the labrum to intertrocanteric crest and line.
84
Q

Hip Joint: Ligaments

A
  • Ischiofemoral
  • Iliofemoral
  • Pubofemoral
  • Transverse acetabular
  • Ligamentum teres
85
Q

Hip joint: Neurovasculature

A

Blood supply:

  • Medial and lateral circumflex femoral
  • Artery of ligamentum teres

Nerve:

  • Femoral and obturator nerves
86
Q

Hip joint: Bursae

A
  • Trochanteric
  • Iliopsoas
  • Gluteus Medius
87
Q

Hip joint: Variants

A
  • Developmental hip dysplasia
  • Coxa valga and vara
  • Labrum variation – triangular / round / absent
  • Os acetabula – superior acetabulum
88
Q

Talocalcaneal joint: Description

A

The talocalcaneous joints are distal to the ankle joint and is locates where the talus rests on the calcaneus allows inversion and eversion.

89
Q

Talocalcaneal joint: Gross anatomy

A

Synovial joint with hyaline cartilage surrounded by capsule

Talus covered with 60% surface with hyaline cartilage

90
Q

Planar joints of the talocalceaneal joints

A

Anterior, middle and posterior articulations with sinus tarsi running between the middle and posterior articulations

91
Q

Talocalcaneal ligaments

A
  • Spring ligament – sustentaculum tali to navicular
  • Interosseous talocalcaneal lig. Thick ligament in sinus tarsi
  • Anterior, posterior, medial and lateral talocalcaneal ligaments
92
Q

Talocalcaneal joints: Neurovasculature

A

Arterial supply:

Anterior and posterior tibial arteries

Peroneal artery

The vascular supply to the talus is considered tenuous due to the lack of muscular attachment to the bone

Innervation: deep peroneal nerve, tibial nerve, saphenous nerve, sural nerves

93
Q

Talocalcaneal joint: Variants

A

Talocalcalcanous coalition of middle facet, posterior or anterior

Absent talus

Ball and socket talocural joint

94
Q

Patellofemoral joint: Description

A

The patellofemoral joint is a saddle joint which is lined with hyaline cartilage (synovial) and sits between the distal femur and articular facets of the patella

95
Q

Patellofemoral joint: Gross anatomy

A
  • Inverted pyramid shaped sesamoid bone of the patella sits within the quadriceps and patella tendon
  • Medial and lateral articular facets on the posterior surface articulate with the medial and lateral patella groove of the femur
  • The lateral facet is the steepest facet
  • Fibrous capsule and synovial membrane continuous with the knee joint
96
Q

Patellofemoral joint: Ligaments

A
  • Patellar ligament – from the apex of the patella to the tibial tuberosity
  • Medial and lateral patellar retinaculum
  • Medial and lateral patellofemoral ligament
97
Q

Patellofemoral joint: Relations

A

Anterior: patella, prepatella bursa

Posterior: Femur and femoral condyles with intercondylar groove

Inferior: Patella tendon, infrapatellar bursa and Hoffa’s fat pad

Superior: Quad tendon and suprapatellar bursa

Medial and lateral: patellar retinaculum

98
Q

Patellofemoral joint: Neurovasculature

A

Arterial:

Medial and lateral, superior and inferior genicular arteries.

Descending branch of geniculate from femoral profunda

Innervation:

Femoral , tibial and common peroneal nerve

99
Q

Patellofemoral joint: Variants

A

Bipartite patella

Dorsal patella defect

Absent patella

100
Q

Lateral collateral ligaments of the ankle: Description

A

A set of three ligaments of the lateral aspect of the ankle

Function: Stabilise the ankle, resist inversion

101
Q

Anterior talofibular ligament

A
  • Horizontal course
  • From the anterior marginal of the lateral malleolus to the lateral talus
102
Q

Calcaneofibular joint

A
  • Vertical course
  • From the inferior aspect of the lateral malleolus to the lateral calcaneus
103
Q

Posterior Talofibular ligament

A
  • Horizontal course
  • Distal lateral malleolar fossa to the lateral tubercle of the posterior talar process
  • Inserts into an Os trigonum if present
104
Q

Superficial medial collateral ligaments

A
  • Tibionavicular
  • Tibiocalcalcaneal
  • Posterior superficial tibiotalar ligament
  • Tibiospring ligament
105
Q

Deep medial collateral ligaments of the ankle

A

Anterior tibiotalar
Posterior deep tibiotalar ligament

106
Q

ACL: Description

A

Anterior cruciate ligament (ACL) is one of the two cruciate ligaments that stabilise the knee joint.

107
Q

ACL: Gross anatomy

A

The ACL arises from the anteromedial aspect of the intercondylar area on the tibial plateau and passes upwards and backwards to attach to the medial aspect of the lateral femoral condyle. (ALP)

Like the posterior cruciate ligament, the ACL is intracapsular but extrasynovial.

The ACL consists of two components:

  • anteromedial bundle (AMB)
  • posterolateral bundle (PLB)
108
Q

PCL: Description

A

The posterior cruciate ligament (PCL) is one of the two cruciate ligaments that stabilise the knee joint.

109
Q

PCL: Gross anatomy

A

The PCL attaches to the posterior intercondylar area and passes anterosuperiorly to insert into the lateral surface of the medial femoral condyle.

When the knee is in extension, it makes an almost 90º turn as it passes anterosuperiorly. The anterior cruciate ligament passes lateral to it and curves around it.

The PCL is intracapsular but extrasynovial and is approximately 13 mm in diameter. It contains two fibre bundles named according to their relative attachments:

  • anterolateral
  • posteromedial
110
Q

Menisci of the knee: Description

A

The knee menisci are fibrocartilaginous structure that sit within the knee joint, deepening the tibiofemoral articulation.

Function: Improve stability, shock absorption and load transmission

111
Q

Menisci of the knee: Gross anatomy

A
  • Two per knee joint medial and lateral.
  • Central body with anterior and posterior horns,
  • Triangular in cross section being thicker peripherally

Medial meniscus:

  • C-shaped
  • Larger of the two

Lateral meniscus:

  • Almost complete circle
  • Smaller of the two
112
Q

Medial meniscus: attachments

A
  • Anterior horn – intercondylar area anterior to the attachment of the anterior cruciate ligament, transverse meniscal ligament
  • Body – attached to the medial collateral ligament
  • Posterior horn – to the posterior intercondylar area between the PCL insertion and the posterior root attachment of the lateral meniscus
113
Q

Lateral meniscus: Attachments

A
  • Anterior horn – lateral to the ACL insertion, transverse meniscal ligament
  • Body – closely related to the popliteus tendon
  • Posterior horn – posterior intercondylar area posterior to the attachment of the posterior horn of the medial meniscus
  • Anterior and posterior meniscofemoral ligaments – from the posterior horn to the lateral aspect of the medial femoral condyle
114
Q

Menisci: Neurovaculature

A

Blood supply:

  • Arterial: Genicular arteries
  • Venous: Genicular veins

Innervation:

  • Tibial and femoral nerves

Lymphatics:

  • Inguinal nodes
115
Q

Menisci: Variants

A
  • Discoid meniscus
  • Hypoplastic or absent
  • Speckled anterior horn
  • Meniscal ossicle
116
Q

Gluteus maximus

A
  • Thick flat sheet muscle of the buttock, most superficial sloping down
  • Origin: Gluteal surface of the ilium bone, lumbar fascia, lateral sacrum
  • Insert: Gluteal tuberosity of femur and iliotibial tract
  • Nerve: Inferior gluteal nerve from L5-S2 sacral plexus
  • Blood: Inferior gluteal artery from anterior division of the internal iliac artery
  • Action: Extend hip and internal rotation
117
Q

Gluteus medius

A
  • Below the glut max and fan shaped
  • Origin: Gluteal Surface of ilium bone between the anterior and posterior gluteal line
  • Insert: Posterolateral portion of the greater trochanter of femur
  • Nerve: Superior gluteal L4-S1 sacral plexus
  • Blood: Superior and inferior gluteal artery
  • Action: internal rotation and abduction
118
Q

Gluteus minimus

A
  • Deepest muscle of the buttocks, covered by glut. Med.
  • Origin: Gluteal surface of ilium between the anterior and inferior gluteal line
  • Insert: anterior surface of greater tuberosity
  • Nerve: Superior gluteal L4-S1
  • Blood: sup and inferior gluteal from IIA
  • Action: internal rotation and abduction
119
Q

Gluteus: Variants

A
  • Gluteus Quartus is a accessory muscle between the medius and minimus
  • Fusion of glut max and tensor fascia lata
  • May be fused with piriformis
120
Q

Gluteus: Relations

A
  • Inferior gluteal nerve runs between the minimus and medius
  • Sciatic nerve emerges deep to the glut max with the inferior gluteal nerve and art
121
Q

Fibularis longus and brevis: Description

A

Both are muscle of the anterior compartment of the leg. Course together with a shared synovial sheath. Together the tendons wrap around the lateral malleolus, specifically within the retromalleolar groove of the distal fibula (brevis tendon is close to bone here).

122
Q

Fibularis longus

A
  • origin: head of the fibula
  • insertion: first metatarsal and medial cuneiform
  • action: plantar flexion and foot eversion
  • arterial supply: fibular artery
  • innervation: superficial fibular nerve
  • antagonist: tibialis anterior
123
Q

Fibularis brevis

A
  • origin: lower two thirds of lateral surface of the fibula
  • insertion: lateral tubercle at base of fifth metatarsal
  • action: plantar flexion and eversion of foot
  • arterial supply: fibular artery (peroneal artery)
  • innervation: superficial fibular nerve
124
Q

Sartorius: Description

A

The longest muscle in the body, crosses the hip and knee joint therefore acting on both joints. Latin for Tailor.

125
Q

Sartorius: Gross anatomy

A

Origin: ASIS from the iliac crest

Course:

  • Runs obliquely across thigh
  • Forms the lateral wall of the femoral triangle
  • Forms the roof of the adductor canal at lower femoral triangle
  • Covers superficial femoral artery and saphenous nerve deep in this canal
  • Medial femoral cutaneous runs medially along muscle

Insertion:

Medial super tibia as part of pes anserinus

Actions:

Flexion and external rotation of the thigh, cross leg movement

126
Q

Sartorius: Neurovasculature

A

Innervation:

Femoral Nerve L2-4

Arterial:

Superficial femoral artery

Vein:

Greater saphenous and superficial femoral vein

127
Q

Sartorius: variants

A
  • The origin may be from the inguinal ligament or pubis
  • Tendon may merge early with the semimembranosus tendon
128
Q

Quadratus femoris: Description

A

The quadriceps is the group of 4 muscles in the anterior compartment of the thigh that connect to the patella via the quadriceps tendon. The muscles are:

129
Q

Rectus Femoris

A
  • origin: straight head originates from the anterior inferior iliac spine (AIIS) of the ilium, the reflected head originates from the ilium just superior to the acetabulum
  • insertion: quadriceps tendon
130
Q

Vastus medialis

A
  • origin: shaft of femur linea aspera
  • insertion quadriceps tendon and medial border of patella
131
Q

Vastus lateralis

A
  • origin: shaft of femur linea aspera
  • insertion quadriceps tendon and lateral border of patella
132
Q

Vastus intermedius

A
  • origin: upper two thirds of the anterior and lateral surfaces of the femur
  • insertion: quadriceps tendon, lateral margin of patella and lateral condyle of tibia
133
Q

Quadriceps femoris: Neurovasculature

A

Innervation:

All four muscles are innervated by the femoral nerve.

Arterial:

All four muscle are supplied by the lateral femoral circumflex

134
Q

Common peroneal N: Gross anatomy

A

Origin: distal thigh superior to the popliteal fossa

Course:

  • Through the popliteal fossa laterally
  • Winds around the fibula neck
  • Enters the lateral compartment of the leg

Supply:

motor supply: short head biceps femoris

sensory supply: cutaneous innervation of posterolateral leg

135
Q

Peroneal N: Branches

A
  • deep peroneal nerve – nerve to the anterior compartment of the leg, runs on the interosseous membrane with the anterior tibial artery, supplies sensory to the first webspace
  • superficial peroneal nerve – nerve supplying the lateral compartment of the leg, sensory to the dorsum of the foot
136
Q

Peroneal N: Relations

A
  • Deep peroneal – runs on the anterior surface of the interosseous membrane with the anterior tibial artery
  • Superficial peroneal – in the lateral compartment of the leg with fibularis longus and brevis
  • Common peroneal runs around the neck of the fibula
137
Q

Peroneal N: Variants

A
  • Aberrant path
  • High division
  • No sciatic nerve
138
Q

Sciatic N: Description

A

The sciatic nerve arises from the sacral plexus from the roots of L4-S3. It is the longest and widest single nerve in the body.

139
Q

Sciatic N: Gross anatomy

A

origin: sacral plexus (L4-S3)

course:

  • exits the pelvis through the greater sciatic foramen
  • courses inferiorly through the posterior compartment of the thigh
  • Divides in the mid-thigh
140
Q

Sciatic N Branches

A
  • tibial nerve(L4-S3)
  • common peroneal nerve(L4-S2)

The tibial nerve is the nerve to the posterior compartment of the leg

The common perioneal nerve supplies the anterior and lateral compartments of the leg

141
Q

Sciatic N: Relations

A
  • Anterior: Deep femoral artery and vein
  • Posterior: Hamstrings
  • Leaves the greater sciatic foramen inferior to piriformis
142
Q

Sciatic N: Variants

A
  • The division of the sciatic nerve into the tibial and common fibular can happen at any point
  • Sciatic nerve above piriformis
  • Sciatic nerve through piriformis
  • Persistent sciatic artery (may be the dominant artery to the leg)
143
Q

Femoral N: Description

A

The femoral nerve is the nerve to the anterior compartment of the thigh

Function: Motor to the anterior compartment, sensory to the anterior and medial thigh

144
Q

Femoral N: Gross anatomy

A

Origin: Lumbar plexus, Roots L2, 3, 4

Course: It passes out from the lateral boarder of psoas

It passes through the retroinguinal space lateral to the common femoral artery

It lies outside the femoral sheath

Termination:

Divides in the superficial and deep divisions

145
Q

Femoral N: Divisions

A

Superficial:

  • Innervate sartorius and the sensory to the anterio-medial thigh

Deep division continues:

  • Large anterior thigh muscle innervation
  • Continues as saphenous nerve which runs through the adductor hiatus then with the great saphenous vein and supplies sensation to the medial leg
146
Q

Femoral N: Variants

A

Multiple femoral nerve slips within psoas

147
Q

Femoral Artery: Description

A

The femoral artery is the primary arterial supply trunk of the lower limb with branches to the anterior abdominal wall.

148
Q

Common femoral artery: Gross description

A

Origin: Continuation of the external iliac artery after passing medial to the midpoint of the inguinal ligament

Course: Short course in the femoral triangle

Termination: Branches to become the profunda femoris and the superficial femoral artery

149
Q

Common femoral artery: Branches

A
  • Superficial epigastric
  • Inferior epigastric
  • Superficial circumflex iliac
  • Superficial and deep external pudendal
150
Q

Profunda femoris

A

Origin: Posterior aspect of the common femoral artery

Course: posteriodistally

Main branches:

Medial and lateral circumflex femoral arteries

(Desending lateral circumflex)

Termination: Within the thigh as perforating arteries

151
Q

Superficial femoral artery

A

Origin: continuation of the common femoral artery after the profundal femoris branch

Course: down the leg deep to satorious enters the adductor canal

Termination: adductor hiatus becomes the popliteal artery

Branches: descending geniculate branch

152
Q

Boundaries of the femoral triangle

A

SAIL

  • Lateral - Sartorius
  • Medial - Adductor longus
  • Superior - Inguinal ligament
  • Floor - iliopsoas (laterally) and pectineus (medially)
  • Roof - Fascia lata
153
Q

Femoral triangle: Contents

A

Femoral – nerve, artery, vein (lateral to medial)

Femoral sheath – thickening of the deep fascia of the thigh

154
Q

Lymphatic drainage of the lower leg: Superficial inguinal

A

The superficial inguinal nodes are located in the superficial fascia of the upper thigh near the inguinal ligament and great saphenous vein. They number around 10 and drain lymph from the gluteal region, inferior anterior abdominal wall, perineum and superficial lower limbs. They drain into the external iliac lymph nodes via channels accompanying the femoral vessels.

155
Q

Lymphatic drainge of the lower limb: Deep inguinal nodes

A

The deep inguinal nodes are located within the femoral sheath, medial to the femoral vein. They receive afferent lymphatic drainage from the deep lymphatics of the distal lower extremity and perineum (e.g. glans penis / clitoris), and drain proximally into external iliac lymph nodes via channels running with the femoral vein. The deep nodes also share common channels with the superficial inguinal nodes.

156
Q

Lymphatic drainage of the lower limb: Popliteal nodes

A

The popliteal nodes are small collection of deep nodes posterior to the knee and they are close to the popliteal vessels. They drain lymph from superficial vessels, which accompany the small saphenous vein, as well as, deep areas of the leg and foot. They drain into the deep and superficial inguinal nodes.

157
Q

Popliteal fossa: Description

A

The popliteal fossa is a diamond or rhomboid-shaped fat-filled space in the posterior knee.

158
Q

Popliteal fossa: Boundaries

A

superolateral: medial border of biceps femoris
superomedial: lateral border of semimembranosus (with semitendinosus superficial to it)
inferolateral: medial border of the lateral head of gastrocnemius
inferomedial: lateral border of the medial head of gastrocnemius
floor: (superior to inferior) femur (popliteal surface), knee joint capsule, popliteus muscle
roof: skin, subcutaneous tissue, fascia lata

159
Q

Popliteal fossa: Contents

A

AVN medial to lateral

fat

  • popliteal artery: deepest, gives off genicular branches
  • popliteal vein: in between the artery and tibial nerve
  • tibial nerve: most superficial
  • small saphenous vein: ascends and pierces the roof to enter the popliteal vein
  • popliteal lymph nodes
160
Q

Tibial plateau: Description

A

The tibial plateau is the proximal articular surface of the tibia.

161
Q

TIbial plateau: Gross anatomy

A

The tibial plateau is composed of two parts:

Concave articular surfaces of the oval-shaped medial and circular-shaped lateral tibial condyles

Intercondylar eminence – site of the attachment of the menisci and cruciate ligaments

Tibial tuberosity – anterior attachment site for the patella ligament

162
Q

Tibial plateau: Neurovasculature

A

Blood supply:

Genicular arteries and veins

Innervation:

Femoral, Tibial and peroneal nerves

Lymphatics:

Inguinal

163
Q

Tarsal tunnel: Description

A

The tarsal tunnel is a fibro-osseous canal found in the medial aspect of the ankle.

164
Q

Tarsal tunnel boundaries

A
  • roof: flexor retinaculum
  • floor: medial surfaces of the tibia, talus and calcaneus
165
Q

Tarsal Tunnel: Contents

A
  • From anterior to posterior:
  • tibialis posterior tendon
  • flexor digitorum longus tendon
  • posterior tibial artery and vein
  • tibial nerve: divides into the medial and lateral plantar nerves within the tunnel
  • flexor hallucis longus tendon
166
Q

Adductor Canal

A

Description:

  • Aponeurotic tunnel in the middle third of the thigh
  • Extending from the apex of the femoral triangle to the opening between the adductor magnus oblique and medial heads (the adductor hiatus)

Boundaries:

  • Anteriorly: sartorius
  • Postermedially: adductor longus, adductor magnus
  • Laterally: vastus medialis

Contents:

  • Femoral artery
  • Femoral vein
  • Branches of the femoral nerve (saphenous nerve, nerve to the vastus medialis)
  • Neither of these branches enter the adductor hiatus
  • The saphenous nerve does not go through adductor hiatus passes medially between sartorius and gracillis
  • The nerve to vastus medialis supplies the muscle prior to the adductor hiatus

Anatomy (11 decks)

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